On May 18, 2017, 15 states and the District of Columbia
filed a motion to intervene in House v. Price, a lawsuit threatening the
availability of federal funds (about $9 billion in 2017) for cost-sharing
reduction (CSR) payments to health insurers under the Affordable Care Act
(ACA). The lawsuit pertains to whether or not CSR payments are subject to
annual Congressional appropriations. It was initially filed in November
2014 in U.S. District Court, which ruled in favor of the U.S. House of Representatives
in May 2016, but held its decision in abeyance pending appeal. It is now
before the U.S. Circuit Court of Appeals in the District of Columbia.
The states argue that uncertainty about federal CSR payments
has directly impacted them: reduced participation by private insurance
companies in individual health insurance markets in many states, less price
competition among insurers, and higher costs for some consumers have been
seen. Over time, it could cause the number of uninsured Americans to go
back up, hurting vulnerable persons and directly burdening the state and local
agencies that serve them. Most immediately, state agencies face imminent
deadlines for the review and approval of 2018 health insurance premiums, an
arduous task compounded by uncertainty about CSR payments and the impact that a
loss of such payments might have on insurance enrollments and risk pools in
each state for 2018.
CSR payments were designed under the ACA to reduce
out-of-pockets costs, such as deductibles and co-payments, for eligible
individuals with incomes under 250 percent of the federal poverty level (FPL),
who might otherwise be unable to afford care despite premium subsidies
available under a separate ACA provision.
As of May 22, 2017, the U.S. House of Representatives (the
plaintiff) and the U.S. Department of Justice (on behalf of the defendant, HHS
Secretary Thomas E. Price, M.D.) have requested the U.S. Circuit Court of
Appeals to continue to hold House v. Price in abeyance for an
unspecified period of time. No decision has yet been made by the court on
the states’ May 18, 2017 motion to intervene.